Critical pathway improves arrival-in-cath-lab interval for patients with acute myocardial infarction in the emergency department

A newly developed critical pathway has been applied to emergency medical ca re of patients with acute myocardial infarction (AMI) in the emergency depa rtment. The arrival-in-cath-lab interval (ACI) was selected as a clinical i ndicator of quality assurance, according to American Heart Association and American College of Cardiology guidelines. This report describes the first experience of applying the critical pathway to patients with AMI in an emer gency department in Japan. The ACI of 35 AMI patients who underwent primary percutaneous transluminal coronary angioplasty during a 24-month period fo llowing application of the pathway were compared with those of 50 AMI patie nts during the 48 months before application of the pathway. The median ACI value was significantly reduced from 65.5 min to 50.0 min. Also, the propor tion of patients with acceptably short ACI (< 60 min) significantly improve d from 42.0% to 68.6%.